Quality initiatives

• Improve member care, service, experience, access and/or safety; and/or
• Improve service to practitioners, providers, employers, brokers and other customers and partners; and/or
• Improve Medica’s internal operations related to care, service, experience, access and patient safety.

The QI program supports Medica’s mission to be the trusted health plan of choice for customers, members, partners and our employees.

Our QI program covers a wide range of topics that affect our members, providers, employers and brokers, as well as our internal staff. We want to be sure that:

• Our members receive high-quality health care and service from our providers.
• Our members can get appointments quickly. We have enough doctors in the areas where our members live.
• Our members get the help they need when they change doctors.
• Our complaint and appeal processes work fairly and efficiently.
• We can offer appropriate help to our members with chronic health problems.
• We can help our members be sure that the care they receive is safe.
• Our members are satisfied with Medica, and we’re identifying areas where we can do better.

To create an effective quality plan, Medica must understand what our customers need, want and believe about health care. We learn about members and other important stakeholders through satisfaction surveys, reports on member complaints and appeals, focus groups, market research and other data that shows the kind of care our members receive and how well it works for them.

When Medica chooses QI projects, we look for the best opportunities to improve care, service and safety for the greatest number of members. These are some of the questions we consider:

• Will this improvement be meaningful to our members?
• Do we have the ability to make a real impact on the problem? 
• How are we doing compared to other local and national health plans? Can we do even better?
• What laws and regulations do we need to consider?
• What will it cost – in dollars, time, and staff – to do this project well?

Once we choose a project, we set a performance goal. We measure progress toward the goal throughout the project to see how effective the improvement is.

Every year, Medica prepares a Quality Improvement Work Plan. The work plan is a summary of the key QI activities we plan for the year. Here are some examples of projects on the current work plan:

Medica has specific Quality Improvement activities focused on reducing disparities in key health outcomes for members enrolled in our Medicaid products.  These include:

• Reducing Disparities in Diabetes Care. Click here for more information.
• Reducing Disparities in Well Child, Prenatal and Postpartum Care. Click here for more information.

Every work plan activity has an “owner” — a Medica staff member who watches over the project and reports on progress. Some projects or goals may change during the year if progress reports show we aren’t getting the results we need. We may also add new projects throughout the year.

Medica evaluates the QI program at the end of each year. The Quality Improvement Program Evaluation is a report that reviews how well we did on our quality improvement activities. In the report, we compare measurements and look for trends to see how well we’ve done over time. If we didn’t meet a goal, we also report on any problems or unexpected happenings that kept us from being successful.

The QI Program Evaluation is an important learning tool for Medica. The information in the report helps us understand how effective our QI program has been, and also helps us make recommendations for the next year’s work plan.

At Medica, quality is everyone’s responsibility. Departments and staff throughout Medica “own” and participate in QI activities. The Senior Medical Director, a licensed physician, is responsible for leading the QI program. Staff in the Quality Improvement department monitor and support program activities.

Medica’s Quality Improvement Subcommittee (QIS) directs and oversees the QI program. QIS is staffed by Medica employees representing key business units across the organization. QIS reports to the Medical Committee of the Medica Board of Directors. The Medical Committee then reports to the full Medica Board of Directors.

MN Community Measurement (MNCM): MNCM develops measures, collects data and creates reports that drive improvement in health care. Its mission is to accelerate health care improvement by public information reporting.

The Leapfrog Group: This national nonprofit collects and transparently reports and compares hospital performance based on their quality of care, giving consumers the information they need to make informed decisions.

MN Department of Health Adverse Events Search: Area hospitals are required to report to the MN Department of Health whenever any of 28 identified preventable adverse events occur.

Minnesota Hospital Quality Report: This site gives you a snapshot of hospital performance in five key areas (heart attack, heart failure, pneumonia, infection prevention and surgical care), along with patient ratings.

Medicare.gov Hospital Compare: This tool allows you to compare hospitals based on their quality of care, patient survey results, rates of readmission, mortality rates and more.

Quality Check: This site lets you see whether a health care organization has been accredited or certified by the Joint Commission.

Nursing Home Report Card: This nursing home report from the State of Minnesota scores area nursing homes on seven quality measures.

Medical errors are more common than many people realize. A government report published by the Institute of Medicine in 2000 found that between 44,000 and 98,000 people die each year because of medical errors in hospitals. Accidents — and near-misses — can also happen in clinics, pharmacies and other care facilities, and even at home, when patients take medicine and follow treatment orders on their own.

Information is probably the single best patient safety tool. When you talk to your doctor, your surgeon, your pharmacist or any other care provider, it's very important to ask questions and make sure you understand the answers. The Agency for Healthcare Research and Quality (AHRQ) has some helpful fact sheets to get you started (these links will take you outside the Medica site).

Medica takes part in many programs that support patient safety.

• Our Quality Resources section provides easy-to-use quality comparisons among primary care clinic systems and hospitals in the Medica network.
• Our nurses visit primary care clinics as part of our Quality Review programs. The quality review includes checks for safety features such as safe medicine storage and emergency medical equipment kept in good working order.